4175 Beaver Dam Rd - ME96140)off
5 5 ao
Date: Site Address:
Tenant:
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
PERMIT TYPE
Applicant's Printed Name
City atBaQali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Staff:
2010 MECHANICAL PERMIT APPLICATION
LI I E &fig KM RC) A 0
Date Received:
Permit #: `ai'O
Permit Fee: '4
Suite #:
Use BLUE or BLACK Ink
Name: FRANK LID lS tit c-A-J Phone: tD X 5L 1-0$O
Address / City / Zip: 411-5 BtRor-5 bNll R 1 ZIN6 /& i+t). 551
Name: Ft-Aft-et. \"k'LAIIfUUA' �C- LUL., License #: 1 ' 4 10 2 -S -1 -- 1 - 0
Address: g3d.s `1't.y�c7ll'T - )\)2
M 10 City: bOLD`t.iV ONLASt-
State: t' do Zip: ` 54 'Li Phone: 1(.0 5 4 Z- I l (y to
Contact %a.1.)C .. VO U& Email: iA.Ca� 1..O.fthE' 't t „ t7
Description of work:
NOTE: Roo
) de. Pie
mou
finical
/ RESIDENTIAL
N/ Furnace
Conditioner
Air Exchanger
Heat Pump
Other
New Replacement Additional Alteration Demolition
and
hanicai equip_
information on
New Construction
_ Install Piping
Gas
RESIDENTIAL FEES:
$50.50 Minimum Add -on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
COMMERCIAL
_ Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install /_ Remove)
** When installing /removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
55•Co® TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation /removal OR Contract Value $ x 1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001 - $2,000 Permit Fee requires a $1.00 surcharge).
_ $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecafl.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit that the work will be, in accordance
with the approved plan in the case of work which requires a review and approval of plans.
x bQ0 W+5 i NorvlPSoiV
x
Applicant's Signature
Reviewed`
Air T est Ges SE
AC s creening inspe